Surgical instrument



May lo 1927' R. H. WAPPLER SURGICAL INSTRUMENT Filed oct. 16, v`1924 2sheets-sheet 1 Muy 1o, 1927.

R. H. WAPPLER SURGICAL INSTRUMENT Filed oct. 1e, 1924' 2 shuts-sheet 2ATTORNEY Patented May 10, 1927.

UNITED' STATES REINI-IOLD H. WAtLER, OF YONKERS, NEW YORK.

SURGICAL NSTRU'MENT.

Application filed October 16, 1924.

My invention relates to surgical instruments oi' the type in which anoperating device such as a pair ot' forceps is connected, detachably orotherwise, with an optical instrument such a cystoscope or endoscope andusually embodying a small instrument known in this art as a telescope,all for the purposes ot enabling the surgeon to look closely intovarious cavities, channels and ducts ot' the human body, and Vto removetherefrom foreign substances such as gall stones, missiles andsupertluous growths.

More particularly stated, my invention vcompreheiuls a. surgicalinstrument ot the general character just mentioned, and provided with apair of jaws and with an endoscope, these parts being each adaptedrelatively to the other so that, with the instrument as a unit insertedinto a cavity ot the body, the jaws of the forceps being open and theoperator making his observations through the endoscope, his lield ofvision has the form of a cone extending out directly through the openingbetween the jaws, or in other words the jaws may be considered as a pairoi. shutters between which 'the operator looks out from the instrument.and thus the operator sees straight ahead ot' the open jaws.

My invention turther contemplates the employment, Vin an instrument otthis general character, of jaws curved or bent and thus adapted to graspobjects located a little to one side trom the iront or distal end ot theapparatus` in connection with an endoscope so arranged that its lieldoit vision e1;- tends laterally and coincides as tar as practicable withthe opening etween the jaws, as above stated. By this arrangement,notwithstanding the unfavorable position ot the object to be seenthrough the endoscope and grasped by the jaws, the operator can stilleasily see it through the endoscope and readily lgrasp it between thejaws, and as a rule as soon as he can see it all he can grasp it bysimply closing the jaws.

li'ly invention further contemplates iniproved nnifchanism connectedwith the jaws o' the forceps and with a pair oi handles tor actuatingthe same so as to enable the operator to shift said handles angularlyaround into an infinite number oit different positions, therebyfacilitating the convenience ot the operator in manipulating the jawswhile holdinggj the handles in any ot said positions, the jaws beingalso as unit Serial No. 743,856.

movable angularly into an infinite number oi? different positions,independently of the positions ot the handles. l 1

My invention further comprehends various improvements in -endoscopes andsurgical forceps adapted for use therewith, and also improvements uponvarious combinations of these parts with others as incorporated in asurgical instrument.

Reference is made to the accompanying drawing forming a part of thisspeciiication and in which like reference characters indicate like partsthroughout the several figures.

Figure l is a side elevation of one forni of my improved surgicalinstrument, in which the torceps jaws are curved, the jaws being hereshown as closed.

Figure 2 is a fragmentary longitudinal cross section through themechanism shown in Figure l. i.

Figure 3 is partly a side elevation and partly a longitudinal sectionol' the mechanism shown in Figure 1, various movable parts being shownas they appear when the jaws are open.

Figure 4 is a section on the line 4-4 of .Figure 2, looking in thedirection indicated by the arrows.

Figur-e is a fragmentary inverted plan showing another form of mydevice, in which the forceps jaws are straight, the jaws being hereshown as closed.

Figure 6 is a side elevation ot the mechanism appearing in Figure 5.

Figure T is a side elevation of the mechanism shown in Figures and 6,but with the jaws open.

I will first describe the form of my device appearing' in Figures l to1l inclusive.

r'i barrel S has a general tubular form, and is provided with a portion9 curved to iiorm a jaw. Another jaw lO, also curved but separate fromthe barrel, is mounted thereupon by means of a pair of journal necks l1which extend into a pair of sockets l2, serving as bearings, and shownmore particularly in Figure Ll. Thus while the jaw 9 is rigid relativelyto the barrel 8 and preferably integral therewith, the jaw l0 is adaptedto move relatively to the jaw 9. lThe jaw l0 carries-a. cross pin 13,extending through a slotI ligas indicated in Figure Ll, and encirclingthis cross pinis an annular bearing l5, provided with an extendingport-ion 16. This extending portion is by means of :tas-

tenings 17 secured upon an operating tube 18.

The operating tube is movable back and Aforth in the general directionoi: its own length, and is used tor actuatingthe inovable jaw 10.

Secured rigidly upon the operatingY tube 18 and thus inovable therewithis an operating` sleeve 18', which extends telescopically into anannular head 19 and also into the adjacent end portion of the barrel 8which is fitted into this annular head, as inay be understood troniFigure 2. The operating` sleeve 18d is provided with a slot 20a. A screwQ extends through the wall o'lt the cylindrical head 19 and the adjacentportion oi' the barrel, and into the slot 20', so as to act as a splinepin. this arrangement the operating sleeve 181L is rendered slidable inthe direction ot its length but is unable to turn upon its axis owing tothe sere-w 2O litting into the slot QOi.

fin annular head 21 is provided with an annular' portion 23 ot reduceddiameter, the annular head 19 beingv similarly provided with an annularportion ot the saine dianiete-r as the portion 28. .ll-i swivel collar2d encircles the two reduced portions 22 and Q8, and abuts neatlyagainst the adjacent body portions ot the two heads 19 and 21.

The swivel collar Qel carries a handle Aintegral with it, this handlehavin` a portion 26 formed into a finger link, as inay he understoodmore particularly 'troni Figure 1. Another handle 2T, having a portion28 lorined into linger linli, is n'iounted upon the swivel collar 2d byineans of a journal pin 29, as shown more particularly in Figures 2 and8.

rl'he operatingl sleeve 18 is provided with an annular bearin` 80, andthe handle 2T is provided with a ball portion 81 fitting neatly into theannularI bearing 30. By this arrangement the handle Q7 inay be .rnovedback and 'lorth upon the journal pin as a center, and when so nioved itcauses the operating sleeve 18, carrying,` the operating` tube 18, to bethrust back and lorth in the general direction ot the length oi? thebarrel 8.

Since the operating sleeve 18(L is unable to turn because held by thescrew acting as a spline pin, and since the swivel collar 24 carryingthe vtwo handles Q5 and 27 is free to turn, it follows that thesehandles an together be rotated around into any required angularposition. For ,this prpoee the ball portion 31, ot' the handle 27inerely glides around in the annular bearing 80, and this is donewithout disturbing' the position ot the operating tube 18.

The operating sleeve 18, and the adjacent end portion et the operating,Ysleeve 18 cured tixedly thereto as above described, are togetherprovided with a spline slot 82, as indicated incre particularlyv inFigure. 2.

A screw 33 extends through a portion ol the annular head 21 and intothis slot and thus serving as a spline pin. By this arrangement theannular head 21 is prevented troni turning, and is maintained always inregistry with the annular head 9.

A pair of: connecting pins 84 and 85 eX- tend tangentially into theswivel collar 9.4-, and engage the respective reduced portions 28 and 22of the annular heads Q1 and 19. For this purpose the reduced portions 23and 2d are provided respectively with annular bearings 84e and 8o, soarranged that the connectingv pins extend through theni tangentially maybe understood troni Fig ures 1 and 2. By this arrangen'ient the swivelcollar 2d serves as a coupling between the annular heads 19 and 21 andholds these heads spaced apart by a detinite distance which never variesand yet the swivel collar and parts carried thereby can turn freely, asabove described. The connecting pin il is provided with a niilled head31S and the connecting pin is similarly `provided with a inilled head3T. Vllhis is t'or the purpose ot facilitating the reinoval, replacementand adjustment ot the connectingI pins.

rEhe barrel 8 carries a hand valve 38, and connect-ed with the lat-teris a rubber pipe 39, lor supplying water into vthe barrel 8. Siniilarly,a hand valve -lO is inounted upon the annular head Q1 tor facilitatingthe discharge or '\vatei. l provide the barrel 8 with a pair oi? educts'a5-1 disposed adjacent the jaws 9 and 10, to facilitate 'the tlow otwater ifroin the barrel 8. lilhen the instru nient is inserted into anycavity ot the body and water is adniitted through the pipe 39 and handvalve 88 into the barrel 8. the water can usually inalte its escapequite Yfreely between the jaws 9 and. 1l); but it the jaws happen to beclosed, or so disposed relatively to the adjacent tissues of the bodythat the water cannot readily uralte .its es cape, it can easily passthrough the educts d1. iftlter the water 'tullils its inission, such torinstance as "ashing out vthe cavity, it llows baclnvardiy through theoperating tube 18, and thence out through the hand valve d0.

An endosrope extends through the o perating tube 18, and isapproriin'iately concentric to the same. rlhis endoscope is ot the kinddescribed in Iny pending` application liled June 25, 1928. Serial Elo.eilig- 239. lt is provided with a prisinoid L13 and a lens 14, thelatter serving as a window, and so (zo-operating' with prisinoid thatthe opera tors field of vision, outwardly 'troni the lens 414i, has theproximate torni olf a cone, the anis ot which is oblique relatively tothe 2general longitudinal axis oi' the endoscope.

A miniature lainp e5 is carried upon the distal end of the endoscope,and projects out into the fixed jaw 9. vided with an enlarged tubularportion l?,

r1`he endoscope is proitl Il t) and with a wire 48, the latter beingconnected with the lamp 45 tor energizing the same. The wire 4-8 isconnected with a metallic collar t9, insulated :trom other portions andused for n'ialiing electrical connections.

The endoscope contains lenses, a pair ot which are shown at 50. lheselenses, the parts 48 and 4.-.9, and the wire #i8 and Aits connectors,are here shown conventionally, as constituting no essential'parts ot' mypresent invention.

Detachabl y niounted uponthe tubular portion 4-7 is an annular head 5l,carrying a dowel piu 52. An annular head 53, encircling the tubularport-ion l?, is provided with a dowel hole 'i-il: into which the dowelpin tits detachablj.

Engaging the annular head 522 is a coupling link 55, having a threadedengagement with the annular head 2l. l`heannular head 53 carries dowelpins 56., which tits into dowel holes 5T. gasket 555. made preferably otrubber, eucircles the tubular portion el? and is located between theannu lar heads 2l and 523. *ly removingl the couplingring the annularhead 533 and gasket 58 can be removed.

Vlxnrated upon opposite sides ot the metal lic ring ett) are a pair otrings 59 and (30 ot insulating material, preferably hard rubber. tuannular head (il carried by the tubular portion 4T, and detachablyconnected ith this annular head. (il is another annular head tti,carrying an indicator knob (33, used as hereinatter described.

Two lenses are shown at (if-t and (S53. the lens 65 serving as an eyepiece.

T he parts 51., 532. and wiriousI other parts to the right thereofaccording to Figure 2, serve collectively the purpose ot a handle torthe endoscope, and enable it to be withdrawn and replaced bodily and asa unit.

With the handle in such position that the dowel pin 52 tits into thedowel hole 54, as indicated in Figure 2, the iiulicator knob G3 alwaysextends in the same plane as that in which the jaws 9 and l() arecurved. 'llheretoie liiynoting the position ot the knob :'33 theoperator can determine the angular direction in which the jaws extend.

The operators tield o't vision, when loolfg ing through the endoscopeand out lthrough the lens 44 at the distal end thereof. is practicallyin the iorm ot a cone, with its apex iin the lens et and its axisextending oblique ly downward and to the lett according to Figures 1 to3 inclusive.

The. parts are so proportioned and arranged that when the jaws 9 Aandl() are wide open. as indicated in Figure 3, the operators tield otvision is at its maximum; or in other words. the hase ot the cone ofvision coincides substantially with the opening between the jaws 9 andl0 according to Figure 3. Such being the case, the jaws are for thispurpose analogous to a pair ot shutters through which the 'operatorcannot see when they are closed, and through which he can see to theextent that they may be opened. The result ot this arrangement is thatthe operator sees in the same proximate direction in which the jawsextend. The optical eli'ect is about the same as i't-the operators eyewere to occupy the position ot the lens del, and the axis ot his fieldof vision were to extend thence obliquely downward to the lettaccordingto Figure 3, so that he could look out between the jaws.

lt t'ol'lows from this arrangement that with the instrument as a unitinserted` into a cavity ot the body and the-operator lool;- ing throughthe endoscope, any object which he can see plainly is of necessitylocated directl y in trout ot the jaws and between them, and thencey infavorable position -to be grasped by the jaws. It also followspractically as a matter of course that the operator, in order to gra-spthe object between the jaws, need do little or nothing except close thejaws. Either before or after closing the jaws the operator can determinethe location ot the object mentioned, at least relatively to the distalend of the instrument, by merely noting the position of the indicatinglinob 3, as above described.

It the cavity contains blood, mucous, dirt or other substance tending toobscure the operators vision, he can wash out the objectionable materialby the flow ot' water through the instrument as above described.

In the torni ot my device shown in Figures 5 to 7 inclusive the barrelappears at (SU, and integral with it is a straight stationary jaw(lo-acting with this stationary jaw is a. movable jaw G8, also straight.'lVith this torni oit my device, or even with the other form alreadydescribed, the water connections may be discarded it' this be desired.

lilith either form of my device the two jaws, itl polished internally,act to some extent as refiectors and thus increase lthe et'- ciency otthe illumination. In the forms shown in Figures l to 4C inclusive, thetorni ot jaw 9 is especially favorable .tor this purpose.

The operation ot my device is as t'ollows:

The \f'arious parts being constructed and assembled as shown in thedrawing and above described, the instrument is ready for use.

' The barrel 8 being thrust into a cavity of the body, the operatorswings the handle 27 into the position indicated for it in Figurethereby causing the jaw l() to assume the position indicated tor it inthis figure. `The operator now looks through the endoscope, and by aidlof light from thelamp 45, can see iis-above described.

Having located an object to be removed,

lou

loa

lil.)

ita

lit

Llt)

Utl

and if need be having shifted the position ot the instrument slightly inorder to bring the jaws into a more 'favorable position, the operatoractuates the handle 2T and thus closes the jaws upon the object to beremoved. rlhis donev` the operator now carefully removes the instrumenttrom the cavity, and in so doing brings out the object now held betweenthe jaws.

lit 'for any reason the operator wishes to shift the general positionot' the two handles 27 and 25, he merely swings them around bodily torthis purpose as above indicated, thereby turning the swivel collar 2stas described. There is no danger ot displacing either ot the handlesrelative to the other, and the handles as a pair can be etlfectivelyoperated in any angular position into which they can thus be turned.

I do not limit mysel't to the precise mechanism here shown and describedas variations may be made therein without departing 'l'rom my invention,the scope ot which is coininensurate with my claims.

l claim:

l. ln a surgical instrument the condi-ination oitI a barrel, a pair othollow jaws .mounted upon one end ot said barrel and arranger to openand shut, and by so doing to open andiclose said end ot said barrel,means controllable by the operator t'or actuating said jaws, and anoptical instrument extending through said barrel and having a tield ofvision substantially in the torni o't' a cone outwardly between saidaws, in such direction that the axis ot the cone coincides substantiallywith the plane ot' movement of the jaws.

2. ln a surgical instrun'ient the combination oi a barrel, a pair otjaws mounted upon one end ot' said barrel, mechanism connected with saidjaws and controllalfile by the operator for the purpose ot causing saidjaws to grip and in so doingI to close said end ot said barrell` anendoscope separate troni said barrel and extending lengthwisetherethrough, said endoscope having a lield ot vision extendinglobliquely `troni the general axis ot the endoscope, said tield ot visionbeing in the form ot a cone so located that its axis coincidessubstantially with the plane ot' relative movement ot' said jaws inclosing.

il. In a surgical instrument the combination ot' a barrel, a pair ot'jaws mounted upon one end ot' said barrel, mechanism connected with saidjaws and controllable by the operator tor causing said jaws to grip andthus to close said `end ot said barrel, an endoscope extendinglengthwise through said barrel and having a tield of vision extendingobliquely outward trom said open end thereof and between. said jaws whenopen, said Vtield of vision having the form ot a cone with its axisentirely within the general plane in which said jaws are to be closed.

4;. In a surgical instrument of the character described the combina-tionot a barrel of substantially tubular form, a jaw rigidly mounted uponsaid barrel and curved so as to extend sidewise therefrom, said jawbeing hollow, another jaw journaled upon said barrel and also curved soas to extend sidewise therefrom, said second mentioned jaw being hollowand movable relatively to said iirst mentioned jaw, operating mechanismconnected with said movable jaw and extending through said barrel torenabling the operator to actuate said movable jaw, and an endoscopeextending through said barrel and havingv a tield of vision in the'torni oiI a cone with its axis oblique to the general longitudinal axisot said barrel, said endoscope being so positioned relatively to saidbarrel and to said jaws that said lield ot vision ot said endoscope isbounded by said jaws when open.

5. ln a surgical instrument of the character described the combinationof a barrel, a pair ot jaws supported thereby and an endoscope extendingaxially through said barrel and into proximity to said jaws, anoperatingl tube connected with one ot said jaws for actuating itrelatively to the other jaw, said operating tube being concentric tosaid barrel and to said endoscope, and mechanism connected with saidoperating tube for moving itl bodily bacl-z and torth in order toactuate said ii'iovable jaw.

(i. ln a surgical instrunient ot the character described a barrel otsubstantially cylind rical torni, a pair of jaws supported by saidbarrel, an operating tube extending through said barrel and connectedwith said jaws, said operating tube beingl movable in the direction etits length tor caiising said jaws to open and close, an operating sleewemountc-d upon said operating tube and having a portion serving as abearing and provided 'with an annular groove, a slip collar encirclingsaid operating sleeve, mechanism coacting with said slip collar andconnected with said operating` sleeve for supporting said operatingsleeve, a movable handle journaled upon said slip collar and providedwith a portion extending into said annular groove, so that when saidhandle is moved back and forth said slip collar communicates motion tosaid operating tube and causes one of said jaws to be actuated, andanother handle mounted upon said slip collar and coacting with saidtirst mentioned handle.

'i'. In a surgical instrument ot' the character described thecon'ibination ot a barrel, a pair of jaws supported by said barrel, anoperating tube connected with one of said jaws and extending throughsaid barrel for operating said jaw, an operating sleeve carried by saidoperating tube and provided with a bearingl ot annular form, a slipcollar encircling said operating sleeve and revoluble relativelythereto, a handle journaled upon said slip Collar and provided With aportion engaging said bearing for causing movements of said ha-ndle toattuate said operating sleeve, and mechanism connected with said slipcollar for supporting said operat iing sleeve.

8. In a surgical instrument the combination of a barrel of substantiallycylindrical form, a pair of jaws supported by said barrel, an operatingtube connected with said jaws for actuating said barrel, an annular headencircling said barrel and secured rgidly thereto, another annular headencircling said barrel and loose relatively thereto, an operating sleevemounted rigidly upon said operating tube and having spline connectionslto said first mentioned annular head and to said second mentionedannular head in order to prevent each annular head from turningrelatively to the other or to said operating sleeve, a slip collarengaging said operating sleeve and portions ol said annular heads, saidslip collar being revoluble relative-v ly to said operating sleeve andto said annular heads, and a pair of handles carried by said slipcollar, one mounted upon said slip eollar and other journaled upon saidslip collar and movable relatively thereto, said last mentioned handlebeing connected with said operating Sleeve and movable for the purposeof actuating theflatter.

Signed at New York, in the county of and tate of N. Y., this 14 day ofOctober, 1924.'

REINHOLD H.y VVAPPLER.

